Treatment planning study comparing proton therapy, RapidArc and intensity modulated radiation therapy for a synchronous bilateral lung cancer case

Suresh Rana, Shyam Pokharel, Yuanshui Zheng, Li Zhao, Dina Risalvato, Carlos Vargas, Nancy Cersonsky


Purpose: The main purpose of this study is to perform a treatment planning study on a synchronous bilateral non-small cell lung cancer case using three treatment modalities: uniform scanning proton therapy, RapidArc, and intensity modulated radiation therapy (IMRT).

Methods: The maximum intensity projection (MIP) images obtained from the 4 dimensional-computed tomography (4DCT) scans were used for delineation of tumor volumes in the left and right lungs. The average 4D-CT was used for the treatment planning among all three modalities with identical patient contouring and treatment planning goal. A proton therapy plan was generated in XiO treatment planning system (TPS) using 2 fields for each target. For a comparative purpose, IMRT and RapidArc plans were generated in Eclipse TPS. Treatment plans were generated for a total dose of 74 CGE or Gy prescribed to each planning target volume (PTV) (left and right) with 2 CGE or Gy per fraction. In IMRT and RapidArc plans, normalization was done based on PTV coverage values in proton plans.

Results: The mean PTV dose deviation from the prescription dose was lower in proton plan (within 3.4%), but higher in IMRT (6.5% to 11.3%) and RapidArc (3.8% to 11.5%) plans. Proton therapy produced lower mean dose to the total lung, heart, and esophagus when compared to IMRT and RapidArc. The relative volume of the total lung receiving 20, 10, and 5 CGE or Gy (V20, V10, and V5, respectively) were lower using proton therapy than using IMRT, with absolute differences of 9.71%, 22.88%, and 39.04%, respectively. The absolute differences in the V20, V10, and V5 between proton and RapidArc plans were 4.84%, 19.16%, and 36.8%, respectively, with proton therapy producing lower dosimetric values.

Conclusion: Based on the results presented in this case study, uniform scanning proton therapy has a dosimetric advantage over both IMRT and RapidArc for a synchronous bi-lateral NSCLC, especially for the normal lung tissue, heart, and esophagus sparing. Further studies on a large group of patients with bi-lateral lung cancer are required to validate the dosimetric superiority of proton therapy over the IMRT and RapidArc.


Cite this article as: Rana S, Pokharel S, Zheng Y, Zhao L, Risalvato D, Vargas C, Cersonsky N.  Treatment planning study comparing proton therapy, RapidArc and intensity modulated radiation therapy for a synchronous bilateral lung cancer case. Int J Cancer Ther Oncol 2014; 2(2):020216. DOI:10.14319/ijcto.0202.16


Synchronous Bilateral; Lung Cancer; Proton Therapy; IMRT; RapidArc; Treatment Planning

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